Care By Us Limited

Updated 3 October 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. This service also provided care and support to people living in 11 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service also provided care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care [and support] service.

The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. One of the registered managers was also the provider.

Notice of inspection

We gave a weeks’ notice of the inspection because the service supports a large number of people and arrangements were needed for contacting and visiting people.

Inspection activity started on 29 April 2019 and ended on 11 July 2019. We visited the office location on 29 April 2019. On 29 April 2019 and 02 May 2019, the Experts by Experience called people and relatives for feedback about the service. On 14 May 2019 we visited a supported living service managed by the provider. Between the 14 May 2019 and 11 July 2019, we contacted health and social care professionals working in partnership with the service and requested further evidence from the provider.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 20 people who used the service and 16 relatives about their experience of the care provided. We spoke with 20 members of staff including the provider, registered managers, managers of the different service types operated by the provider, senior care workers and care workers.

We reviewed a range of records. This included six people’s care records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 3 October 2019

About the service

Care by Us Limited is a large organisation which offers personal care and other bespoke services in East, West and North Hertfordshire, Essex and North London. The organisation is operated from two locations. This inspection covered the services provided in East and North Hertfordshire and West Essex.

The service provided a wide range of services which included, domiciliary care, 24-hour live-in care, enablement services, prevention of hospital admission, ‘Front of House’ service that turned around people at A&E to get them home and prevent hospital admission, delirium recovery pathway, early stroke discharge service, extra care schemes and supported living for young adults with learning disabilities.

The diverse services meant that a large number of people were supported with the regulated activity of personal care. For example, at the time of the inspection, there were around 800 people who received personal care. The number of people receiving support varied significantly in numbers from day to day due to the short term support some people received. In one year, there were approximately 3000 people who received care and support from the service totalling approximately one million care hours.

The service also supported 65 people with learning disabilities. 27 people lived in 11 supported living establishments and 35 people in the community.

People were extremely positive about the service they received. Every person and relative we spoke with from the different services told us they received care which was safe and enabling. People told us they were not just enabled to live in their own homes which was their main goal, but felt in charge of their care, had become more independent and their health was promoted and did not require hospital admissions.

People were educated how to take risks safely and protect themselves from the risk of abuse. This was in addition of staff being well trained and knowledgeable about safeguarding procedures and how to report their concerns.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People using the service told us how much they achieved and developed since using the service and how happy they were with the life they were living. Staff were trained and supported to meet the diverse needs of people using the service including those related to disability, gender, ethnicity, faith and sexual orientation. These needs were recorded in care plans and all staff we spoke with knew the needs of each person well.

The provider operated a bespoke training programme developed and adapted to provide staff with in-depth knowledge about legislation, approved best practice guidelines and health conditions people using the service lived with. The training programme focused on practical face to face training in an environment specially adapted by the provider to resemble to the type of environment their client group lived in.

The provider and staff were passionate in enabling people to live independently in their own homes for as long as possible and they used assistive technology to promote safety. The effective use of innovative technology had measurable impact on vulnerable people at risk of dehydration and those at risk of getting lost when leaving their home.

People received personalised care and support, and this was flexible to fully meet their needs. The provider yearly budgeted a large sum to enable them throughout the year to provide free of charge bespoke services, equipment and often household goods to people who could not continue live at home without this.

The provider developed services for people who were at risk of social isolation. They commenced pet therapy support and offered this service free of charge to people who missed having pets to stroke and talk to and these had many positive benefits for people. They also looked after people’s pets when they were no longer able to so that people continued to enjoy the company of their animals.

People told us they were supported by a stable staff team who they developed good relationships with. They told us staff were extremely caring and often they went over and above their professional duties. This made people feel valued and safe living in their own homes.

The provider developed a close working relationship with commissioners and local authorities from their catchment area to develop new services in response to the needs of people in the community. Commissioners and representatives from the local authority’s social work team told us the support they received from the provider was invaluable. In their recent contract monitoring visit the provider achieved an ‘Excellent’ overall rating.

The provider’s quality assurance systems were self-developed and tested all aspects of the service they provided. The systems were highly effective in identifying any issues or areas where improvement was needed to the quality of the service provided. The effectiveness of the monitoring systems were constantly tested and improved. This led to effective deployment and management of staffing resources across all their services with only 20 missed visits recorded in a year out of 1.2 million. The visits were marked as missed because staff were more than two hour late arriving at people’s homes.

The providers were involved in developing and sharing best practise in their areas of expertise often mentoring and supporting other providers of similar services. They were nominated and won several awards to recognise their contribution of improving people’s life in the community. The provider ran several well-being programmes for their employees. The award schemes and development opportunities offered to their staff contributed to the development of a strong, dedicated and motivated staff team who adhered to the vision and the values promoted by the provider.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 09 September 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.